The following information is presented for educational purposes only.
Medical Marijuana Inc. provides this information to provide an understanding
of the potential applications of cannabidiol. Links to third party websites
do not constitute an endorsement of these organizations by Medical Marijuana
Inc. and none should be inferred.
Chronic inflammation is caused by abnormal behavior in the immune system and
can lead to tissue, joint and organ damage. Studies have shown marijuana is
effective at reducing chronic inflammation associated with a variety of
diseases and can help patients manage the pain associated with their
Overview of Inflammation
While inflammation is an essential response by the body’s immune system to
injury, bacteria and viruses, at times the inflammatory response is called
upon unnecessarily. When called upon appropriately, the inflammatory
response effectively removes the infectious or damaging stimuli so that the
body can initiate the healing process. However, when called upon
unnecessarily, in the case of autoimmune diseases, the immune system reacts
as if tissues are infected or abnormal when in actuality they are normal. As
a result, the body causes damage to its own tissues.
Acute inflammation that comes and goes as necessary to deal with injuries
and diseases represents a well-balanced and effective immune system. With
chronic inflammation, however, the immune system is essentially
“out-of-wack” as it won’t shut off the inflammatory response.
Examples of diseases that are associated with inflammation include
rheumatoid arthritis, a chronic inflammatory disease that causes joint
destruction, deformity and loss of function, psoriatic arthritis, which
causes joint pain, stiffness and swelling, as well as red patches on the
skin, Crohn’s and other inflammatory bowel diseases where the digestive
tract becomes inflamed, atherosclerosis, the inflammation of arterial walls
that can limit or block blood flow and cause heart attacks and stroke, and
Treatment of inflammatory diseases typically involves anti-inflammatory and
pain medications and the modifying or avoidance of particular activities
that stress the inflamed area. In certain cases, surgery is required.
Findings: Effects of Cannabis on Inflammation
Medical marijuana has been found to be effective at both reducing chronic
inflammation and at curtailing the pain associated with inflammatory-related
diseases, thanks to its two major cannabinoids, tetrahydrocannabidiol (THC)
and cannabidiol (CBD).
Both THC and CBD have demonstrated success at reducing inflammation related
to a variety of conditions. Studies have shown that THC is able to reduce
the development of atherosclerosis, the chronic inflammatory disease and a
major risk factor of heart attacks and strokes, and at reducing airway
inflammation related to the flu virus (Fimiani, et al., 1999) (Buchweitz, et
al., 2008). CBD has been found to have the capability of reducing joint
inflammation and has demonstrated effective at inhibiting the disease’s
progression (Sumariwalla, et al., 2004) (Nagarkatti, et al., 2009). CBD has
also shown to effectively reduced edema (Costa, et al., 2004). In terms of
Crohn’s disease, cannabis is able to lower the digestive track inflammation
and has even demonstrated it can improve the chances of reaching complete
remission (Naftali, Mechulam, Lev & Konikoff, 2014) (Nagarkatti, et al.,
2009). Studies also suggest that the cannabinoids in marijuana may be
beneficial in certain types of cancers that are triggered by chronic
inflammation (Nagarkatti, et al., 2009).
While both THC and CBD have demonstrated anti-inflammatory effectiveness,
the way each goes about it varies. Both cannabinoids decrease the production
and release of pro-inflammatory cytokines and decrease the activation of the
LPS-induced STAT1 transcription factor, a key factor in some of the
pro-inflammatory process. CBD, however, also reduces the activity of the NF-kappaB
pathway, a primary pathway regulating pro-inflammatory genes, and
upregulates the activation of the STAT3 transcription factor, which induces
anti-inflammatory events (Kozela, et al., 2010). CBD also assists in
anti-inflammation efforts by suppressing fatty acid amidohydrolase activity,
which results in an increased concentration of the anti-inflammatory
endocannabinoid, anandamide (Burstein & Zurier, 2009).
Inflammatory pain is a common symptom of a number of chronic inflammation
diseases, such as sickle cell disease and cancer, but cannabis has proven
helpful in pain management. The cannabinoids in cannabis act upon the
cannabinoid receptors 1 and 2 (CB1, CB2), which are involved in the
mediation of pain associated with inflammation (Clayton, Marshall, Bountra &
O’Shaughnessy, 2002) (Elikottil, Gupta & Gupta, 2009) (Kehl, et al., 2003).
Studies have also found that CBD is effective in reducing neuropathic pain
by reducing the inflammation causing sciatic nerve construction (Costa, et
States That Have Approved Medical Marijuana for Inflammation
Inflammation is not specifically included on the list of approved conditions
for medical marijuana in any state. However, many states do include specific
inflammation-related conditions. Medical marijuana is approved for patients
with arthritis in Connecticut (psoriatic
arthritis), California, Illinois and
Patients diagnosed with Crohn’s disease are allowed to legally use marijuana
for treatment in Arizona, Arkansas, Connecticut,
Florida, Georgia, Hawaii, Illinois (and
other irritable bowel syndromes), Louisiana, Maine (and
other irritable bowel syndromes), Massachusetts, Michigan, Minnesota, Montana, New
Jersey (and other irritable
bowel syndromes), New
York (and other irritable
bowel syndromes), North
Dakota, Ohio, Pennsylvania, Rhode
Island and Washington. Connecticut has
also approved medical marijuana to treat ulcerative colitis, another type of
irritable bowel syndrome.
If an inflammation-related condition is causing chronic pain, medical
marijuana has been approved for treatment in Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Maryland, Michigan, Montana, New
Mexico, Ohio, Oregon, Pennsylvania, Rhode
Island and Vermont.
The states of Nevada, New
Dakota, Montana, Ohio and Vermont allow
medical marijuana to treat “severe pain.” The states of Arkansas, Minnesota, Ohio, Pennsylvania and Washington have
approved cannabis for the treatment of “intractable pain.”
A number of other states will consider approving medical marijuana for the
treatment of other conditions, but require an approval or a recommendation
by a physician. These states include: California (any
debilitating illness where the medical use of marijuana has been recommended
by a physician), Connecticut (other
medical conditions may be approved by the Department of Consumer
Protection), Massachusetts (other
conditions as determined in writing by a qualifying patient’s physician), Nevada (other
conditions subject to approval), Oregon (other
conditions subject to approval), Rhode
Island (other conditions
subject to approval), and Washington (any
“terminal or debilitating condition”).
D.C., any condition can be approved for medical marijuana as long as a
DC-licensed physician recommends the treatment.
Recent Studies on Cannabis’ effect on Inflammation
The two major cannabinoids present in marijuana (THC, CBD) are effective
Cannabinoids Delta(9)-tetrahydrocannabinol and cannabidiol differently
inhibit the lipopolysaccharide-activated NF-kappaB and
interferon-beta/STAT proinflammatory pathways in BV-2 microglial cells.
THC decreased throat inflammation in mice with swollen air pathways from
the flu virus.
Targeted deletion of cannabinoid receptors CB1 and CB2 produced enhanced
inflammatory responses to influenza A/PR/8/34 in the absence of presence
The administration of THC reduced the development of atherosclerosis, an
inflammatory disease of the blood vessels that causes heart attacks and
Opiate, cannabinoid, and eicosanoid signaling converges on common
intracellular pathways nitric oxide coupling.
A review of past studies on cannabis’ ability as an anti-inflammatory
agent supports cannabis as an effective treatment in the physiology of
Cannabinoids, endocannabinoids, and related analogs in inflammation.
Buchweitz, JP., Karmaus, PW., Williams, KJ., Harkema, JR. and Kaminski,
NE. (2008, March). Targeted deletion of cannabinoid receptors CB1 and
CB2 produced enhanced inflammatory responses to influenza A/PR/8/34 in
the absence of presence of Delta9-tetrahydrocannabinol. Journal of
Leukocyte Biology, 83(3), 785-96.
Burstein, S. (2015, April). Cannabidiol (CBD) and its analogs: a review
of their effects on inflammation. Bioorgaic & Medicinal Chemistry,
Burstein, SH. and Zurier, RB. (2009, March). Cannabinoids,
endocannabinoids, and related analogs in inflammation. The AAPS Journal,
Clayton, N., Marshall, FH., Bountra, C., and O’Shaughnessy, CT. (2002,
April). CB1 and CB2 cannabinoid receptors are implicated in inflammatory
pain. Pain, 96(3), 253-60.
Costa, B., Colleoni, M., Conti, S., Parolaro, D., Franke, C., Trovato,
AE., and Giagnoni, G. (2004, March). Oral anti-inflammatory activity of
cannabidiol, a non-psychoactive constituent of cannabis, in acute
carrageenan-induced inflammation in the rat paw. Naunyn-Schmiedeberg’s
Archives of Pharmacology, 369(3), 294-9.
Costa, B., Trovato, AE., Comelli, F., Giagnoni, G., and Colleoni, M.
(2007, February). The non-psychoactive cannabis constituent cannabidiol
is an orally effective therapeutic agent in rat chronic inflammatory and
neuropathic pain. European Journal of Pharmacology, 556(1-3), 75-83.
Elikkottil, J., Gupta, P. and Gupta, K. (2009, November-December). The
analgesic potential of cannabinoids. Journal of Opioid Management, 5(6),
Fimiani, C., Liberty, T., Aquirre, AJ., Amin, I., Ali, N. and Stefano,
GB. (1999, January). Opiate, cannabinoid, and eicosanoid signaling
converges on common intracellular pathways nitric oxide coupling.
Prostaglandins & Other Lipid Mediators, 57(1), 23-34.
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